Stirling Smith on the ethical procurement of NHS medical supplies

Welcome to a series of blogs on sustainable healthcare that will look at health, sustainability, and the interplay between the two. The blog will share ideas from experts across the healthcare field, some of whom are speaking at a major European conference looking at Pathways to Sustainable Healthcare in September 2013. More about the Cleanmed conference can be seen at

Bangladesh is as good as any place to start thinking about the origins of goods and services used in the NHS. People may associate it with big fashion brands, but the country is a major source of uniforms and workwear.

Of course, Bangladesh has been in the news for all the wrong reasons lately. Last year a horrendous fire killed more than 100 workers—many were not allowed to leave work by their supervisors even though the alarms were ringing and they could smell smoke. Barely a few months after came the horrific collapse of a building containing several garment factories, and 1157 workers were crushed to death. It’s not just factories where these things happen—94 patients and staff were killed in a fire in a hospital in the Indian city of Kolkata (Calcutta) in December 2011. The causes were identical to the garment factory fire a year later in the Bangladeshi capital, Dhaka, 150 miles away.

Health workers and patients have plenty of things to occupy their minds, and complex supply chains that can lead half way around the globe may not be high on their list of priorities.

But can any of us—patients, their families, and health workers—feel comfortable with the thought that the sheets, or latex gloves, or surgical instruments, or cleaning services, are provided by workers in conditions we would not accept?

But isn’t this imposing our standards on developing countries? It is a question I am sometimes asked when delivering training for the Ethical Trading Initiative (ETI), which is running ethical procurement workshops for suppliers, procurement staff, and clinicians during the CleanMed event.

Surely there is nothing particularly British or western in expecting that you won’t be burned to death in the factory where you work, or poisoned by toxic substances, or that the building where you arrive in the morning won’t fall down because it was built in violation of safety rules? It is not an especially British idea to want to be treated fairly, or for your children to go to school, and not be forced to work with hot metal to make single use surgical instruments?

In fact the standards which the ETI asks its members to follow are simply those adopted by the United Nations system. They are universal and in many cases already incorporated into the laws of most countries. These are the ETI’s principles:

No forced or child labour; the right to form or join a trade union; basic health and safety at work; a living wage; reasonable working hours; no discrimination; proper contracts; and no bullying.

These are basic human rights, surely? They should not just apply to those of us in developed countries?

And by using the spending power of the health service on goods and services we can try to make a difference. Procurement for goods and service provides an opportunity to push suppliers to reveal the source of products, and the steps taken to provide workers with a minimum level of protection.

It has been done already. In Wales, a recent contract for nurses’ uniforms required compliance with the ETI Base Code and asked for labour standards audit at supply sites. NHS Supply Chain has introduced Labour Standards requirements into framework contracts for surgical instruments and direct textiles.

Clinicians can call on their NHS Trust or Commissioning Group to commit to improving lives for workers by implementing an ethical procurement strategy. The BMA’s Medical Fair and Ethical Trade Group has produced a set of simple steps you can take and there are lots of tools and sources of help:

Competing interests: I declare that that I have read and understood the BMJ Group policy on declaration of interests and I have no relevant interests to declare.

Stirling Smith wrote this blog during a recent visit to Dhaka; he is an ethical trading expert and an ETI trainer. Stirling will be running workshops at the CleanMed conference.